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Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund * MCPAC This Site Secured By SSL Encryption
Donation Information
Donation Amount *
Payment Method * Credit Card
Employer *
MN Law requires full disclosure including employer and occupation for contributions
Occupation *
MN Law requires full disclosure including employer and occupation for contributions
Compliance Statement *
I understand that Minnesota state law requires this donation must be made from my personal account, not a business account. I take responsibility for complying with state law regarding this contribution.
Donor Comments
Donor Information
First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
Location
Postal Code*
Phone *
Billing Information
[ Click here if billing address is the same as donor address ]
 *  
Organization 
Address *
Address Cont.
City/Town *
Country *
Location
Postal Code*
Billing Phone *


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